VRHA Weekly Update
In this Issue  January 15, 2018

VRHA News Virginia News National News Mark your calendar
Funding Opportunities


January Newsletter




2018 VRHA Officers

The VRHA Board of Directors has selected its officers for 2018:

  • President - Summer Sage
  • Vice President - Steve Sedlock
  • Secretary - Portia Brown
  • Treasurer - Mike Zodun 
Thanks to Summer, Steve, Portia & Mike for being willing to serve VRHA in this capacity!

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Members in the News

From the Auburn Plainsman

The American Osteopathic Foundation has named [VRHA member] VCOM President and Provost Dr. Dixie Tooke-Rawlins as the organization’s board president for 2018.

Tooke-Rawlins is the current president and provost of the Edward Via College of Osteopathic Medicine (VCOM) in Blacksburg, Virginia, as well as its branch campuses in Spartanburg, South Carolina, and Auburn.

Read the full article.

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More Members in the News

From Valley Health

Valley Health System and [VRHA member] Warren Memorial Hospital (WMH) have announced their intent to begin construction in 2018 on a new, contemporary medical campus on Leach Run Parkway in Warren County. If the project proceeds as planned, Valley Health anticipates the new facility will open in late 2020.

Read the full press release.

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Virginia News

Legislative Watch

Bills recently introduced in the General Assembly which could have an impact on health and healthcare in rural Virginia.

HB 175 & SB134 : Certain hospital licenses; effective date. Provides that a license issued to an acute care hospital located in Patrick County that was valid on September 1, 2017, and remained valid on December 31, 2017, despite the closure of such hospital prior to December 31, 2017, shall continue to remain valid until December 31, 2018.

HB 793: Nurse practitioners; practice agreements. Eliminates the requirement for a practice agreement with a patient care team physician for nurse practitioners who are licensed by the Boards of Medicine and Nursing and have completed at least 1,040 hours of clinical experience as a licensed, certified nurse practitioner. 

HB 641: Prescription Monitoring Program; recipients of dispensed Schedule II drugs. Requires pharmacists who dispense Schedule II drugs pursuant to a valid prescription to include the name, address, and government-issued identification number of the person to whom the covered substance was actually delivered in the report submitted to the Prescription Monitoring Program. 

HB 759: Certificate of public need; exception. Authorizes the State Health Commissioner to accept, review, and issue a certificate of public need for the establishment of a new ambulatory surgery center located in Planning District 5 for the provision of endoscopic services. 

HB 573: Health insurance rate reviews; pharmacy benefit price spread. Requires the State Corporation Commission (Commission) to treat the price spread on any contract between the issuer of a health benefit plan and its pharmacy benefit manager as an administrative cost of the issuer.

HB 777: Emergency air medical transportation; informed decision. Requires emergency medical services personnel, prior to initiating contact with an emergency air medical transportation provider for air transport of a patient, to obtain written consent from the patient after disclosing certain information. 

HB 806: Closure of the Southwestern Virginia Training Center and the Southeastern Virginia Training Center prohibited. Provides that the Southwestern Virginia Training Center and the Southeastern Virginia Training Center shall not be closed and shall instead remain open and continue to accept new admissions of individuals with intellectual disability for whom treatment in a training center is appropriate. 

HB 778: Health care providers; notices; health benefit plan networks; air ambulance providers. Requires a health care provider, before arranging for air ambulance services for an individual known to be covered under a health benefit plan, to provide the covered person or his authorized representative a written disclosure and obtain the covered person's or his representative's signature on the disclosure document.

HB 872: Hospitals and nursing homes; frequency of inspections. Clarifies, in provisions governing frequency of hospital and nursing home inspections, that a second inspection of a hospital or nursing home that has previously been inspected may be performed before all other hospitals and nursing homes in the Commonwealth have been inspected in cases in which the subsequent inspection is necessary to comply with federal regulations governing inspection and certification of hospitals and nursing homes. 

HB 607: Department of Behavioral Health and Developmental Services; recovery community organization pilot program. Directs the Department of Behavioral Health and Developmental Services to implement a pilot program to evaluate the recovery community organization model of substance abuse treatment. 

HB 882: Prescribers; notice of administration of naloxone. Requires every hospital that operates an emergency department to develop and implement a protocol for (i) identifying every prescriber who has prescribed opioids to a patient to whom naloxone is administered for the purpose of reversing an opioid overdose in the emergency department or by emergency medical services personnel or a law-enforcement officer prior to admission to the emergency department in the twelve month period immediately preceding the administration of naloxone and (ii) notifying each such prescriber that the patient has been treated with naloxone for the purpose of reversing an opioid overdose.

HB 878: Delivery of Schedule VI prescription devices. Provides that a permitted manufacturer, wholesale distributor, warehouser, or third-party logistics provider or registered nonresident manufacturer or nonresident wholesale distributor may distribute Schedule VI prescription devices directly to a patient on behalf of a medical equipment supplier.

SB 436: Schedule I drugs; classification for fentanyl derivatives. Adds to Schedule I of the Drug Control Act a classification for fentanyl derivatives.

HB 503: Prescription Monitoring Program; disclosure of information; fitness to work and return to work evaluations. Adds the following individuals to the list of individuals to whom the Director of the Department of Health Professions (the Director) may disclose information about a specific recipient contained in the Prescription Monitoring Program:

HB 572: Pharmacy contracts; disclosures by pharmacists. Requires contracts between a carrier and its intermediary regarding the provision of pharmacy services by participating pharmacy providers and any provider contract between a carrier and a participating pharmacy provider or its contracting agent to contain specific provisions that prohibit the carrier or intermediary from restricting a participating pharmacy provider's disclosure of any relevant information to an individual purchasing a prescribed drug.

HB 886: Admissions for mental health treatment; toxicology. Requires the Board of Health to include in regulations governing hospitals a provision that requires every hospital that provides inpatient psychiatric services to establish a protocol that requires, for every refusal to admit a patient for whom there is a question of medical stability or medical appropriateness for admission due to toxicology results, the on-call physician in the psychiatric unit to which the patient is sought to be transferred to participate in direct verbal communication, either in person or via telephone, with a clinical toxicologist or other person who is a Certified Specialist in Poison Information employed by a poison control center that is accredited by the American Association of Poison Control Centers to review the results of the toxicology screen and determine whether a medical reason for refusing admission to the psychiatric unit related to the results of the toxicology screen exists. 

HB 933: Mandatory outpatient treatment; time period. Extends the time period for mandatory outpatient treatment for adults and juveniles from 90 days to 180 days. 

HB 935: Mandatory outpatient treatment; consent. Eliminates the requirement that a person agree to abide by the plan for mandatory outpatient treatment before mandatory outpatient treatment may be ordered. 

HB 1001: Health care shared savings; incentive programs. Requires health carriers to establish a comparable health care service incentive program under which savings are shared with a covered person who elects to receive a covered health care service from a lower-cost provider.

HB 954: Commission for a Healthy Virginia; report. Establishes the Commission for a Healthy Virginia

SB 370: Delivery of prescription drug orders. Provides that whenever any pharmacy delivers a prescription drug order for which refrigeration is required by mail, common carrier, or delivery service, when the drug order is not personally hand delivered directly, to the patient or his agent at the person's residence or other designated location, the shipment shall include a means for the (i) detection of temperature variations that may cause chemical degradation of the drugs and (ii) notification of the patient of the variation. 

HB 832: Certificate of public need; exception. Authorizes the State Health Commissioner to accept, review, and issue a certificate of public need for open heart services in Planning District 8, provided that certain conditions are met.

HB 874: Certificates of public need. Creates a three-phase process to sunset certificate of public need requirements for many categories of medical care facilities and projects, with the requirement for a certificate of public need eliminated 

HB 918: Certificate of public need; certain projects. Provides a permitting process for projects converting into an outpatient or ambulatory surgical center

HB 1002: Permits for certain medical care facility projects; civil penalty. Exempts projects in Planning District 11, other than those involving nursing homes, from the requirement to obtain a certificate of public need 

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Joint Expansion Priorities

From the Office of the Governor

Governor Terry McAuliffe and Governor-elect Ralph Northam proposed their joint legislative agenda for the 2018 General Assembly session. The legislative package includes proposals to expand Medicaid, implement universal background checks in order to purchase a gun, reform the absentee voting process, formally join the Regional Greenhouse Gas Initiative (RGGI), prevent the personal use of campaign contributions, raise the felony larceny threshold, institute a Borrower’s Bill of Rights creating an ombudsman who can help borrowers understand their payments, and support for the Whole Women’s Health Act.

The Governor and Governor-Elect offered their support for language in the proposed budget that would expand access to healthcare for nearly 400,000 low-income Virginians, create 30,000 new jobs and save Virginia taxpayers more than $400 million over the next two years. This expanded access would help working Virginians who make too much to qualify for the Commonwealth’s current Medicaid program but too little to afford coverage on their own.   

Read the full press release and related story fom ABC13.

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Market-Based Care

By Megan Stanley - Jacobin

The goal of universal coverage has long eluded the Affordable Care Act — especially in rural areas. Because insurers have less financial incentive to offer plans in less densely populated places, residents have an especially hard time finding health coverage through the ACA exchanges.
The dire state of rural health access was driven home for me recently when I went looking for health coverage. After returning from several months out of the country, my husband and I signed up on healthcare.gov and put in his family’s address in Caroline County, a rural area outside Richmond, Virginia. While we expected to find few options, especially compared to our previous address in Northern Virginia, we were both shocked by the results. Our search turned up just two insurers and eight plans. All of them included a deductible and charged exorbitant rates for two people in their thirties.
As a point of comparison, we decided to look up the rates for a similar silver-level plan in Pittsburgh (Allegheny County), where we’re moving later this year. The premiums were almost half of those in the rural Virginia exchange, and we could easily select a zero-deductible plan, instead of the hefty $3,600 deductible we were saddled with in the other plans.

Read the full editorial.

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National News

Expansion = Fewer Closed Hospitals

By John Daley - NPR

The expansion of Medicaid helps rural hospitals stay afloat in states like Colorado, which added 400,000 people to the health insurance program under the Affordable Care Act.  Hospitals in states that expanded Medicaid were about 6 times less likely to close than hospitals in non-expansion states, according to a study by researchers at the University of Colorado Anschutz Medical Campus.

Colorado was one of 32 states to expand Medicaid under the Affordable Care Act. That cut the state's uninsured rate in half. The biggest group that got coverage was childless adults.  Richard Lindrooth, a professor at the Colorado School of Public Health and lead author of the study, says hospitals saw more people showing up to hospitals with that insurance — so Medicaid payments increased. That helped the hospitals' bottom line.

Brock Slabach, senior vice president of the National Rural Health Association, says the study correlates with data the group has reviewed. "If state legislatures and Congress want to cure the rural hospital closure problem, expanding Medicaid and not block-granting this important program would be the answer," he says.

Read the full article and related story from Healthcare Dive.

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The Next Big HIV Outbreak

By Laura Ungar - Louisville Courier Journal 

Andiria Tipton figured it was her job, as the older kid, to crawl around under a bed and pick up dirty drug needles. She’s matter-of-fact about why: “I had to keep them from my little sister.”
Andiria has learned a lot about the hellish world of addiction in her short 10 years. But she’s also found refuge from it as one of eight kids being raised by Lisa Lacy-Helterbrand, who takes in children of people struggling with addiction. All but one began life in drug withdrawal.
Addiction is endemic in these Appalachian hills. It’s gained so much ground that the nation’s foremost health experts fear one plague will spawn another, that rampant intravenous opioid use will lead to a drug-fueled HIV outbreak like the one that struck Austin, Indiana in 2015. That outbreak was the largest to hit rural America in recent history, with a rate comparable to countries in Africa.

Read the full article.

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Maternal Care is Missing

By Taylor Blatchford

Maternal health care in rural areas saves lives, and Dr. Randy Tobler knows that firsthand.  The obstetrician in Memphis, a town of 1,800 in northeast Missouri, remembers a woman who came in for delivery whose uterus had ruptured before she went into labor. She lived just 15 minutes from Scotland County Hospital, the only one in a four-county area. If she’d had to travel much farther, she would have died, Tobler said.

It’s emergencies like these that make access to maternal health care so important, he said. But in more than two-thirds of rural Missouri, a pregnant woman can’t go to a hospital with obstetric services to give birth in her county.

Of the state’s 101 rural counties, 43 have no hospitals, according to a Missouri Department of Health and Senior Services document updated in October 2017. Another 26 counties have hospitals, but not dedicated obstetric beds.

Read the full article.

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Insurers to Come Out Ahead

By Susannah Luthi and Virgil Dickson - Modern Healthcare

Despite a year of policy delays, glitches and uncertainty, insurers may be the ones to come out ahead of other segments of the industry in 2018. Uncertainty and policy confusion will no doubt continue this year since House and Senate Republicans are already on different pages when it comes to healthcare reform.

Who's going to do well in this environment? Whether you look at Centene Corp. in the individual market or the likes of UnitedHealthcare, CVS Health and Aetna competing for greater market share, including the Medicare Advantage space, the payer community is poised to fare well in the new Wild West of policy. This despite the fact that last year's tax overhaul effectively killed the individual mandate by eliminating the penalty for people who fail to obtain coverage.
For other stakeholders—hospitals and providers who have watched helplessly as key programs lapsed without Congress mobilizing to fund them, or the Trump administration pivoting on value-based payment initiatives—the future isn't necessarily so bright.

Read the full article.

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Mark Your Calendar

For more information about these and other events, visit the VRHA Calendar

February 6-8: Rural Health Policy Institute - Washington, DC
March 3: Educational Forum on Prescription Drug Abuse - Martinsville
March 4: Educational Forum on Prescription Drug Abuse - Roanoke
April 15-17: MATRC Annual Telehealth Summit - Hershey, PA
May 8: Health Equity Conference - New Orleans, LA
May 8: Rural Medical Education Conference - New Orleans, LA
May 8-11: Annual Rural Health Conference - New Orleans, LA
May 8-11: Rural Hospital Innovation Summit - New Orleans, LA

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Rural Schools and Health 
This guide has been updated with a new Frequently Asked Question on what rural schools can do to help address Adverse Childhood Experiences in their students.

Robert Wood Johnson Foundation
Applications are now open for four of RWJF’s leadership development programs. These programs are helping build the leaders of tomorrow—leaders who share a commitment to ensuring everyone has the opportunity to live the healthiest life possible.
RWJF’s leadership development programs are designed to help you advance your leadership skills, and connect you with other innovators to advance big ideas and solutions.

  • Culture of Health Leaders: for people from all sectors—from leaders in technology and business to architects and urban planners.
  • Clinical Scholars: for clinicians from all disciplines, from occupational therapists and pharmacists to dentists and nurses.
  • Health Policy Research Scholars: for second-year doctoral students from all fields of study—from economics and political science to epidemiology and behavioral science.
  • Interdisciplinary Research Leaders: for researchers and community partners (e.g., organizers, advocates, leaders), particularly those working in rural health.

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Funding Opportunities

For funding opportunities without a specific deadline, please visit the VRHA Resources page

2018 STEM Essay Contest 
Five scholarships (one in each of five regions) to a female high school junior or senior who will be pursuing a STEM education at an institution of higher education.
Deadline: February 8

Open Society U.S. Programs Drug Policy Project
The Open Society U.S. Programs Drug Policy Project aims to support viable alternatives to mass criminalization and mass incarceration, to strengthen community-driven health services, and to provide resources for interventions made prior to or instead of arrests. The Drug Policy Project is currently seeking proposals from high quality pre-arrest and pre-booking diversion programs that reduce arrests and incarceration and provide participants with effective harm reduction interventions. Grants of up to $75,000 will be provided to nonprofit organizations and public agencies that are ready to access the services of technical assistance experts to meet specifically identified areas of needed improvement.
The application deadline is February 1, 2018. 

Kessler Foundation: Signature Employment Grants
The Kessler Foundation’s Signature Employment Grants provide support for non-traditional solutions that increase employment outcomes for individuals with disabilities. Grants ranging from $100,000 to $250,000 per year for up to two years are awarded nationally to fund pilot initiatives, demonstration projects, or social ventures that lead to the generation of new ideas to solve the high unemployment and underemployment of people with disabilities (PWD). Preference is given to interventions that overcome specific employment barriers related to long-term dependence on public assistance or advance competitive employment in a cost-effective manner. For 2018 the Foundation has a special interest in transportation projects that focus on innovative solutions to help PWD seek, obtain, or retain employment, as well as innovative projects that improve employment opportunities and provide jobs for PWD that have been formerly incarcerated or encountered the criminal justice system. Nonprofit organizations, public or private schools, and public institutions, such as universities and government agencies based in the United States or any of its territories are eligible to apply.
Online grant concepts are due February 18, 2018; invited proposals must be submitted by June 15, 2018. 

AmeriCorps Affiliate Program 
Program that provides education awards for youth and adults that provide 100 hours of service to their communities through approved AmeriCorps Affiliate programs. This is a a pilot initiative to engage more youth in service and to increase the number of national service positions available through local support.
Letter of Intent (Optional): Jan 22, 2018 
Application Deadline: Feb 21, 2018 

Screening, Brief Intervention and Referral to Treatment Program 
Grants to implement screening, brief intervention, and referral to treatment services for adolescents and adults in primary care and community health settings for substance misuse and substance use disorders.
Application Deadline: Feb 21, 2018 

Foundation for Rural Service
Each year, the foundation gives out $2,500 scholarships to an exceptional group of rural students for their first year of college or vocational school. Additionally, several named scholarships (listed below) are given to a select group of the over 1,500 applicants.
Deadline: March 1

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